Appetite and Ghrelin Levels in Iron Deficiency Anemia and the Effect of Parenteral Iron Therapy: A Longitudinal Study

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2020 Jun 5

PMID 32497136

Citations 7

Authors

Hanin Ghrayeb

Mazen Elias

Jeries Nashashibi

Awni Youssef

Mari Manal

Liala Mahagna

Masalha Refaat

Naama Schwartz

Adi Elias

Affiliations

Soon will be listed here.

Abstract

Background: Iron deficiency anemia (IDA) is associated with decreased appetite. The ghrelin hormone is one of the major regulators of appetite.

Objectives: To evaluate appetite and ghrelin levels in patients with IDA, and to investigate the change in appetite and ghrelin following intravenous iron therapy.

Methods: A total of 56 IDA patients and 51 controls were included in the study. Both appetite and ghrelin were assessed at baseline and following intravenous iron therapy. These were assessed at corresponding time intervals in the control group. Appetite was assessed by the SNAQ score (Simplified Nutritional Appetite Questionnaire) and fasting ghrelin levels were assessed by acylated ghrelin (AG), unacylated ghrelin (UAG) and their respective ratio AG/UAG.

Results: IDA patients had significantly lower SNAQ scores, yet higher AG levels and higher AG/UAG ratios compared to healthy controls; the mean SNAQ scores were 12.56 ± 3.45 and 16.1 ± 2, respectively (P<0.01); the median AG levels were 57.5 pg/ml and 43 pg/ml respectively (P = 0.007); and the median AG/UAG ratios were 0.48 and 0.25 respectively (P = 0.04). On multivariate linear regression analysis, IDA remained independently associated with decreased SNAQ score (β = -0.524, P<0.001) and increased acylated ghrelin (β = 0.289, P = 0.013). After IDA was treated, SNAQ scores increased significantly by a mean of 2 points. AG and AG/UAG ratios decreased significantly by a mean of -18.44 pg/ml and -0.2 respectively. The control group showed no significant change in SNAQ scores or ghrelin at corresponding time intervals.

Conclusions: IDA patients have a reduced appetite and paradoxically elevated ghrelin hormone activity compared to healthy controls. Treating IDA enhances appetite and lowers ghrelin levels. Future studies are needed to explore the mechanism of this paradoxical ghrelin activity.

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References

Yakabi K, Kawashima J, Kato S . Ghrelin and gastric acid secretion. World J Gastroenterol. 2008; 14(41):6334-8. PMC: 2766114. DOI: 10.3748/wjg.14.6334. View

Korbonits M, Goldstone A, Gueorguiev M, Grossman A . Ghrelin--a hormone with multiple functions. Front Neuroendocrinol. 2004; 25(1):27-68. DOI: 10.1016/j.yfrne.2004.03.002. View

Auerbach M, Ballard H . Clinical use of intravenous iron: administration, efficacy, and safety. Hematology Am Soc Hematol Educ Program. 2011; 2010:338-47. DOI: 10.1182/asheducation-2010.1.338. View

Isguven P, Arslanoglu I, Erol M, Yildiz M, Adal E, Erguven M . Serum levels of ghrelin, leptin, IGF-I, IGFBP-3, insulin, thyroid hormones and cortisol in prepubertal children with iron deficiency. Endocr J. 2007; 54(6):985-90. DOI: 10.1507/endocrj.k07-031. View

Delhanty P, Neggers S, van der Lely A . Mechanisms in endocrinology: Ghrelin: the differences between acyl- and des-acyl ghrelin. Eur J Endocrinol. 2012; 167(5):601-8. DOI: 10.1530/EJE-12-0456. View

Briggs D, Enriori P, Lemus M, Cowley M, Andrews Z . Diet-induced obesity causes ghrelin resistance in arcuate NPY/AgRP neurons. Endocrinology. 2010; 151(10):4745-55. DOI: 10.1210/en.2010-0556. View

Nakai Y, Hosoda H, Nin K, Ooya C, Hayashi H, Akamizu T . Plasma levels of active form of ghrelin during oral glucose tolerance test in patients with anorexia nervosa. Eur J Endocrinol. 2003; 149(1):R1-3. DOI: 10.1530/eje.0.149r001. View

Campillos M, Cases I, Hentze M, Sanchez M . SIREs: searching for iron-responsive elements. Nucleic Acids Res. 2010; 38(Web Server issue):W360-7. PMC: 2896125. DOI: 10.1093/nar/gkq371. View

Al Massadi O, Tschop M, Tong J . Ghrelin acylation and metabolic control. Peptides. 2011; 32(11):2301-8. DOI: 10.1016/j.peptides.2011.08.020. View

10.

Otto B, Cuntz U, Fruehauf E, Wawarta R, Folwaczny C, Riepl R . Weight gain decreases elevated plasma ghrelin concentrations of patients with anorexia nervosa. Eur J Endocrinol. 2001; 145(5):669-73. View

11.

Lawless J, Latham M, Stephenson L, Kinoti S, Pertet A . Iron supplementation improves appetite and growth in anemic Kenyan primary school children. J Nutr. 1994; 124(5):645-54. DOI: 10.1093/jn/124.5.645. View

12.

Stoltzfus R, Chway H, Montresor A, Tielsch J, Jape J, Albonico M . Low dose daily iron supplementation improves iron status and appetite but not anemia, whereas quarterly anthelminthic treatment improves growth, appetite and anemia in Zanzibari preschool children. J Nutr. 2004; 134(2):348-56. DOI: 10.1093/jn/134.2.348. View

13.

Cui H, Lopez M, Rahmouni K . The cellular and molecular bases of leptin and ghrelin resistance in obesity. Nat Rev Endocrinol. 2017; 13(6):338-351. PMC: 8904083. DOI: 10.1038/nrendo.2016.222. View

14.

McLean E, Cogswell M, Egli I, Wojdyla D, de Benoist B . Worldwide prevalence of anaemia, WHO Vitamin and Mineral Nutrition Information System, 1993-2005. Public Health Nutr. 2008; 12(4):444-54. DOI: 10.1017/S1368980008002401. View

15.

Skikne B, Lynch S, Cook J . Role of gastric acid in food iron absorption. Gastroenterology. 1981; 81(6):1068-71. View

16.

van der Lely A, Tschop M, Heiman M, Ghigo E . Biological, physiological, pathophysiological, and pharmacological aspects of ghrelin. Endocr Rev. 2004; 25(3):426-57. DOI: 10.1210/er.2002-0029. View

17.

Dogan A, Alioglu B, Dindar N, Dallar Y . Increased serum hepcidin and ghrelin levels in children treated for iron deficiency anemia. J Clin Lab Anal. 2013; 27(1):81-5. PMC: 6807358. DOI: 10.1002/jcla.21566. View

18.

Rabito E, Marcadenti A, da Silva Fink J, Figueira L, Silva F . Nutritional Risk Screening 2002, Short Nutritional Assessment Questionnaire, Malnutrition Screening Tool, and Malnutrition Universal Screening Tool Are Good Predictors of Nutrition Risk in an Emergency Service. Nutr Clin Pract. 2017; 32(4):526-532. DOI: 10.1177/0884533617692527. View

19.

Topaloglu A, Hallioglu O, Canim A, Duzovali O, Yilgor E . Lack of association between plasma leptin levels and appetite in children with iron deficiency. Nutrition. 2001; 17(7-8):657-9. DOI: 10.1016/s0899-9007(01)00570-6. View

20.

Camaschella C . Iron deficiency. Blood. 2018; 133(1):30-39. DOI: 10.1182/blood-2018-05-815944. View